Provider Demographics
NPI:1780640029
Name:CARR, WILLIAM MICHAEL (MD,FAAP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:CARR
Suffix:
Gender:M
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 GARRISONVILLE RD
Mailing Address - Street 2:SUITE209
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1545
Mailing Address - Country:US
Mailing Address - Phone:540-659-0111
Mailing Address - Fax:540-720-5867
Practice Address - Street 1:385 GARRISONVILLE RD
Practice Address - Street 2:SUITE209
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1545
Practice Address - Country:US
Practice Address - Phone:540-659-0111
Practice Address - Fax:540-720-5867
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780640029Medicaid